Stomach (Gastric) Cancer: Allen’s Story

Allen Wang was eating breakfast on an April morning in 2008 when he had a strange feeling in his stomach. His wife, Alice, suggested that he avoid drinking coffee for a few days and see if he felt any better.

Even though the feeling subsided, Allen decided to have it checked by his doctor because he had had a stomach ulcer once before. The doctor used an endoscope — a flexible, lighted tube with a lens on its tip — to examine his stomach and remove a few tiny samples for biopsy.

It's “Something Bad”

“After a week, the doctor called me and said he found something bad — he found cancer,” Allen recalls.

“My first thought was 'Why me?' My daughter's wedding was in June, so I asked him what I should do.” Allen's doctor referred him to a surgeon at a community hospital in Queens, New York, who, within minutes of meeting Allen, scheduled a surgery for the following week. The surgeon told Allen that as part of the surgery he would have to remove two-thirds of his stomach, which also would require a large incision. The doctor warned Allen that the recovery time would be lengthy, and Allen would need to make many dietary changes.

Uncertain about his options, Allen consulted his daughter, Carol, who encouraged him to get a second opinion at Memorial Sloan Kettering Cancer Center in Manhattan.

A Less Invasive Surgical Option

Within a week, Allen had an appointment at Memorial Sloan Kettering to see Vivian Strong, a surgeon who specializes in the treatment of stomach cancer. She had him undergo another endoscopy with one of the hospital's gastrointestinal specialists and sent him for a number of tests, including a CT scan. With results in hand, Dr. Strong told Allen that his stomach cancer had been found very early and was stage 1, meaning that the cancer was only in the innermost lining of the stomach so only one-third of the stomach would need to be taken out in order to remove the tumor. Dr. Strong also informed Allen that he was a candidate for a less-invasive procedure called laparoscopy, which should make the recovery a little easier.

Laparoscopy is a surgical procedure that is performed using a thin, lighted tube with a video camera at its tip (called a laparoscope). The laparoscope is inserted through a tiny incision in the abdominal wall. Guided by this highly magnified image, the surgeon can operate through six tiny surgical “ports” using specially designed surgical instruments.

“ [Dr. Strong] said to me, 'Don't worry — I'm going to take care of you’…It touched my heart. She's very, very nice and treated me like a friend. “

Allen Wang

Having a doctor who could explain the medical details in a clear, simple way was important to Allen and his wife because English is not their native language — the couple, who have been married 34 years, immigrated to the United States from Taiwan in 1984. “My English is not very good, so after Dr. Strong said something, she would ask me if I understood.”

After Dr. Strong explained the surgery to him, Allen remembers that she asked him if he wanted her to be his surgeon. “I said yes. I had a feeling that she was the right one.”

Surgery — After His Daughter's Wedding

With Dr. Strong's OK, Allen decided to delay the operation until late June, after his daughter's wedding. A few minutes before surgery, Dr. Strong came into the operating room and took Allen's hand. “She said to me, 'Don't worry — I'm going to take care of you. When you wake up, everything will be fine,'” Allen recalls.

During the surgery, in addition to removing the cancer in his stomach, Dr. Strong removed 24 lymph nodes from his abdominal region to determine if the cancer had spread beyond the stomach. All of the nodes came back cancer-free.

Allen was able to go home three days later and was back to work 25 days after that. The recovery time following traditional open surgery can last between two to three months, so he was glad to be back to his regular routine in less than a month.

Follow-Up Treatment

During one of the first follow-up appointments about a month after surgery, Dr. Strong recommended that Allen see her colleague, medical oncologist Raymond Meng, to talk about what additional, adjuvant treatment might be necessary.

“ Working at a place like Memorial Sloan Kettering is a privilege and it is clear that the patients expect the very best from their physicians. Patients like Mr. Wang are the reason I enjoy my profession so much. “

Vivian Strong , Surgeon

The standard course of treatment after stomach cancer surgery is combination chemotherapy and radiationtherapy for a series of weeks. Dr. Meng advised Allen to undergo this additional treatment to reduce the chance of his cancer coming back (recurrence), but Allen was opposed to having chemotherapy, which he viewed as toxic to his body. Because Allen's lymph nodes were clear of cancer, Dr. Meng did not press Allen to pursue additional treatment unless the cancer recurred at any point in the future.

A Few Lifestyle Changes

As Allen learned throughout the course of his treatment, two of the strongest risk factors for developing stomach cancer are being Asian and having a diet high in salty foods and red meat. Prior to his diagnosis and surgery, Allen consumed a lot of red meat; his favorite food was Asian-style barbeque, which is very high in salt. With the help of his wife, Allen has been able to completely change his diet — he now eats lots of chicken and fish, fruits and vegetables, and no sweets. “My wife takes care of me — I really appreciate it. We are even closer than before,” he explains.

Going forward, Allen feels better than ever and is grateful for every day. “It's very scary when you go to the doctor and he says you have cancer. But it happened, and we had to face it.”

abdominal (ab-DAH-mih-nul)

Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

biopsy (BY-op-see)

The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

cancer (KAN-ser)

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

chemotherapy (KEE-moh-THAYR-uh-pee)

Treatment with drugs that kill cancer cells.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

CT scan (… skan)

A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

diagnosis (DY-ug-NOH-sis)

The process of identifying a disease, such as cancer, from its signs and symptoms.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

diet (DY-et)

The things a person eats and drinks.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

endoscope (EN-doh-SKOPE)

A thin, tube-like instrument used to look at tissues inside the body. An endoscope has a light and a lens for viewing and may have a tool to remove tissue.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

endoscopy (en-DOS-koh-pee)

A procedure that uses an endoscope to examine the inside of the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

FISH

A laboratory technique used to look at genes or chromosomes in cells and tissues. Pieces of DNA that contain a fluorescent dye are made in the laboratory and added to cells or tissues on a glass slide. When these pieces of DNA bind to specific genes or areas of chromosomes on the slide, they light up when viewed under a microscope with a special light. Also called fluorescence in situ hybridization.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

follow-up (FAH-loh-up)

Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

gastrointestinal (GAS-troh-in-TES-tih-nul)

Refers to the stomach and intestines. Also called GI.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

incision (in-SIH-zhun)

A cut made in the body to perform surgery.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

laparoscope (LA-puh-ruh-SKOPE)

A thin, tube-like instrument used to look at tissues and organs inside the abdomen. A laparoscope has a light and a lens for viewing and may have a tool to remove tissue.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

laparoscopy (LA-puh-ROS-koh-pee)

A procedure that uses a laparoscope, inserted through the abdominal wall, to examine the inside of the abdomen. A laparoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

lens (lenz)

A clear disk that focuses light, as in a camera or microscope. In the eye, the lens is a clear, curved structure at the front of the eye behind the pupil. It focuses light rays that enter the eye through the pupil, making an image on the retina (light-sensitive layers of nerve tissue at the back of the eye).

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

lymph (limf)

The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

medical oncologist (MEH-dih-kul on-KAH-loh-jist)

A doctor who specializes in diagnosing and treating cancer using chemotherapy, hormonal therapy, biological therapy, and targeted therapy. A medical oncologist often is the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

radiation (RAY-dee-AY-shun)

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

stage (stayj)

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

stomach (STUH-muk)

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

stomach cancer (STUH-muk KAN-ser)

Cancer that forms in tissues lining the stomach. Also called gastric cancer.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

surgeon (SER-jun)

A doctor who removes or repairs a part of the body by operating on the patient.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

surgery (SER-juh-ree)

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

therapy (THAYR-uh-pee)

Treatment.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

toxic (TOK-sik)

Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

tumor (TOO-mer)

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

ulcer (UL-ser)

A break on the skin, in the lining of an organ, or on the surface of a tissue. An ulcer forms when the surface cells become inflamed, die, and are shed. Ulcers may be linked to cancer and other diseases.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

will (wil)

A legal document in which a person states what is to be done with his or her property after death, who is to carry out the terms of the will, and who is to care for any minor children.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)